Several studies this year have given a significant amount of clinical indicators and predictors for low back pain in our patients and the population at large. Below are the summaries of some recent studies that allow us to better refine our diagnosis and prognosis for low back pain, and support our conservative methods to spine care.
- Taylor, et al. in a systematic review found 3 clinical findings that predict potential low back pain episodes within the next 12 months:[i]
- Decreased lumbar lordosis.
- Decreased lumbar lateral flexion range of motion.
- Restriction in Hamstring range of motion.
- Zheng and Chen confirmed that lumbar disc degeneration is the driver of low back pain as we age.[ii]
- Taylor, et al in a systematic review and meta-analysis concluded that previous episodes of low back pain is a consistent predictor of future incident . They also found women were at greater risk than men for developing LBP[iii]
- Tonosu j, et al. found that on lumbar MRI findings consistent with Pfirrmann grade ≥3, disk bulging, and High Intensity Zones may be one of the predictive signs of recurrent severe LBP.[iv]
Figure 1. Image reference panel shows increasing severity of disc degeneration. The pertinent features of each grade are described in Table 1. Three images reflect the inherent variability across each grade.
From: Griffith, J.F., Wang, Y., Antonio, G.E., Choi, K.C., Yu, A.B., Ahuja, A.T., & Leung, P. (2007). Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine, 32 24, E708-12.
- Steffans, et al. in a systematic review found that exercise and education are the main interventions to reduce the risk of LBP. [v]
- Breen,, A, et al. demonstrated that patients with treatment-resistant nonspecific back pain have greater aberrant intervertebral motion values than controls, especially if the former have received spinal surgery.[vi]
- Whedon, et al. revealed that low back pain patients who received chiropractic services has less adverse drug events than those who did not receive chiropractic services. [vii]
- D’Aprile, et al. showed that using fat saturated lumbar MRI and a contrast medium to an standerd MRI protocol for patients with suspected non-disc-related low back pain could allow a better identification of degenerative-inflammatory changes more likely associated to the pain.[viii]
- Coulter, et al. in a systematic review and meta-analysis revealed that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. [ix]
- Morishita, et al. in a study of 152 participants found that those with degenerative changes in the upper segments of the lumbar spine (L1–2 or L2–3 segments) were more likely to have spondylosis of the cervical spine. [x]
- Rosenhagen, et a. uncovered that knee misalignment in youth competitive athletes , especially if combined with high training volume (over 7 hours/week), might be of predictive for developing chronic low back pain later (7 year follow-up in the study). [xi]
- Suri, et al. found that nonsurgical treatment of patients with lumbar disc herniation and radicular pain had a high (43%) recurrence rate for back pain, and a 25% recurrence of radicular pain 1 year following the resolution from treatment. They noted that these recurrence rates are similar for patients who undergo lumbar surgical decompression.[xii]
- Furman and Johnson using provoking epidural injections showed that lumbar dermatomal pain referral patterns are frequently different than those classic lumbosacral dermatomal maps.[xiii]
- Goubert, et al. found that lumbar MRI studies of patients with continuous chronic low back pain have higher amount of fat infiltration in the lumbar muscles, even in the absence of clear atrophy when compared to recurrent low back pain patients. [xiv]
- Hincapié found no evidence of excess risk for acute lumbar disc herniation requiring early surgery associated with chiropractic care compared with primary medical care. [xv]
- Van den berg, et alin a systematic review of the association of inflammatory biomarkers in the blood and the frequency and severity of nonspecific low back pain (NsLBP). They found moderate evidence for a positive association between the pro-inflammatory biomarkers CRP and IL-6 and the severity of NsLBP, and a positive association between TNF-α and the presence of NsLBP.[xvi]
About The Author
Dr. David Graber is the chairperson of the ANJC Council on Technique and Clinical Excellence. He maintains a private practice in Parsippany, NJ. He can be reached at: drdavidgraber@gmail.com. His blog, ChiroExcellence, can be found at: https://drgraber.wordpress.com.
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418732/
[ii] httpwho were nonreipients of chiropractic services.s://tbiomed.biomedcentral.com/articles/10.1186/s12976-015-0020-3
[iii] https://www.ncbi.nlm.nih.gov/pubmed/24462537/
[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214701/
[v] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2481158
[vi] https://www.ncbi.nlm.nih.gov/pubmed/29926209
[vii] https://www.ncbi.nlm.nih.gov/pubmed/29843912
[viii] https://www.ncbi.nlm.nih.gov/pubmed/29350649
[ix] https://www.thespinejournalonline.com/article/S1529-9430(18)30016-0/fulltext
[x] https://www.asianspinejournal.org/journal/view.php?doi=10.4184/asj.2018.12.2.343
[xi] https://www.sciencedirect.com/science/article/pii/S0167945717304001?via%3Dihub
[xii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866041/
[xiii] https://www.thespinejournalonline.com/article/S1529-9430(18)30254-7/fulltext
[xiv] https://www.sciencedirect.com/science/article/pii/S1529943017301821
[xv] https://www.ncbi.nlm.nih.gov/m/pubmed/29038870/
[xvi] https://www.ncbi.nlm.nih.gov/pubmed/29960111
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